Clinical and biochemical predictors of carotid intima media thickness in adolescents with type 2 diabetes

Abstract

The aim of this study was to identify clinical parameters associated with increased carotid intima media thickness (CIMT) in adolescents with type 2 diabetes. Overweight children and adolescents are at increased risk of type 2 diabetes and early development of atherosclerotic lesions and cardiovascular complications. Patients were selected among diabetics who presented to diabetes out patients’ clinic. Criteria for selection were age (12–19 years), being overweight (BMI above the 95th percentile for age and gender), normal or high C-peptide, and negative studies for islet cell antibodies. Age and gender matched healthy subjects, were enrolled as a control group. Laboratory investigations included lipid profile, hypersensitive C-reactive protein (hs-CRP), HbA1c and assessment of insulin resistance by HOMA. According to HbA1c, patients were divided into, uncontrolled group (with HbA1c >6.5) and controlled group (with HbA1c ⩽ 6.5). Ultrasonographic analysis of CIMT was performed for all participants and its association with risk variables was analyzed. BMI, triglycerides, C-reactive protein, HbA1c and HOMA were significantly higher in diabetic patients than the controls. CIMT, HbA1c, systolic blood pressure, triglycerides, HOMA and C-reactive protein were significantly higher in uncontrolled than controlled diabetics, while there was no significant difference between the two groups as regard BMI, total cholesterol, LDL, HDL and C-peptide. In diabetic patients, CIMT correlated positively with BMI, duration of diabetes, systolic and diastolic blood pressure, HbA1c, HOMA, and C reactive protein. CIMT is increased in adolescents with type 2 diabetes as compared to control subjects. Poor glycemic control, HOMA, increased C reactive protein, BMI, duration of diabetes and elevated blood pressure are associated with early atherosclerosis in these patients.